Dr. Jeffrey Kronson: Veins Be Gone
Beauty Now
Teri Hausman

Episode 67 - Dr. Jeffrey Kronson: Veins Be Gone

Dr. Jeffrey Kronson tells Beauty Now listeners all they need to know about varicose and spider veins. This affects not only women but men too. Be honest, you have noticed veins on people wearing shorts. Worse, have you noticed your own veins and thought well maybe I could do something? Well you can and now you will also know the warning signs of a more serious vein problem..

Download this episdode today, get a pencil because you will need it to understand what type of vein problem you may have. This episode is filled with no nonsense advice and can actually save your life with these direct helpful tips, warning signs and treatments. Do not hide your legs one day longer. Take good care of you with the many tips that Dr. Kronson shares with us. Go on and flaunt those legs after you get the help you need. Start here. Beauty Now on I tunes. Dr. Kronson is a board certified general and vascular surgeon. Veins be gone.



Teri Struck: I’m Teri Struck, host of Beauty Now, a weekly podcast that brings you beauty from the inside out. Since I was a child my dad would tease me about putting mud on my face from the garden. You know what, he was pretty much right. We’ve done shows now on everything from lashes, lifts, breast augs, tummy tucks, hair, teeth, and more importantly self esteem and lifestyle tips. Today, you know women, we’ve got those leg veins, spider veins, the pregnancy veins – you kind of look at them and you’re like what are you going to do with these? Well guess what, today we have an expert with us, a board certified surgeon and vascular surgeon, Dr. Jeff Kronson. Welcome to the show.

Dr. Jeffrey Kronson: Thank you very much. It’s good to be here.

Teri Struck: Thanks for being with us today. I think women don’t know what to do when they see these veins, and I think there’s all different types of veins and maybe you can explain to us what are varicose veins and spider veins.

Dr. Jeffrey Kronson: Varicose veins are a symptom of an underlying problem, known generically as chronic venous insufficiency. And this is more common than you might think Teri. One in ten Americans faces the problem of chronic venous insufficiency. What that means is the blood is not getting pumped back into the heart against gravity through your veins properly. Veins have these one-way valves, and when those valves become incompetent or non functional the blood tends to pool in your feet that causes all kinds of symptoms of chronic venous insufficiency, one of which is varicose veins.

Teri Struck: Well can they be dangerous for your health?

Dr. Jeffrey Kronson: They can be life threatening in a couple of instances. People with venous insufficiency develop venous ulcers. They appear in the inside of your leg just above the ankle, and they can erode into your skin and sometimes they can cause uncontrollable bleeding. People…

Teri Struck: Well how do you know if you have this? I mean, so you’re looking at your legs and you see a vein that doesn’t look pretty to us, but that can also be dangerous.

Dr. Jeffrey Kronson: Most of the spider veins that we see and the little bluish veins that we see under the skin are not dangerous. Before the veins become dangerous people will experience symptoms of venous insufficiency that if they are able to recognize them they’ll know something’s going on. For example, most people who stand on their legs, on their feet all day long - if they work at a job in retail for example or in a medical office – will often complain of fatigue and heaviness at the end of the day if they have venous insufficiency. They’ll complain of tiredness. Sometimes it’ll get as bad as constant burning or itching. The end of that scale leaves people with varicose veins that bulge out of their legs, either in the thigh or in the calf, and even further than that are large erosions of the skin just above the ankle on the inside. That’s sort of the end of the spectrum. But if you are standing all day and you get swelling, burning, itching and…

Teri Struck: Now are you saying burning and itching in your legs or would that be all over your body?

Dr. Jeffrey Kronson: Just in your legs.

Teri Struck: Just in your legs.

Dr. Jeffrey Kronson: Venous insufficiency is a problem mostly of your lower extremities. Some folks do have it in their arms, but I see 99 percent of the patients in my office and in my clinic for the legs. So we’re talking lets mostly below the knee.

Teri Struck: So walk us through a consultation.

Dr. Jeffrey Kronson: Well if somebody comes in to see me with spider veins – those are the little red and bluish, you know, squiggly lines on your legs – we talk about their general medical history. You know, I’m the physician and surgeon first, so I’m going to take a good history of a potential patient.

Teri Struck: Which is really important for any doctor, you know, to talk about your history, and we always stress that on Beauty Now, that you want to make sure that your doctor cares about your history rather than just the cosmetic look of things.

Dr. Jeffrey Kronson: Well that’s a real good point because there are some reasons not to do procedures on varicose veins. I ask about the history of blood clots; either the patient has any, if they have any blood clots, is there any history of blood clots in the family, are they on any blood thinners, etcetera… etcetera like that. And then we go through a general physical examination, and as a vascular surgeon I’m going to, you know, look at them from head to toe. It doesn’t take very long, not more than a minute to a minute and a half, that I’ll get a real good idea of what kind of shape they’re in. We of course talk about their medications and any previous operations they may have had, and that’s all fairly routine. We specifically ask about symptoms. We talk about things that might interfere with their activities and daily living; are they able to stand, do their legs feel tired or, you know, fatigued at the end of the day, do they wake up in the middle of the night with burning or itching, do they have restless leg syndrome – that’s a common problem that occurs that has nothing to do with varicose veins…

Teri Struck: Now we see commercials on restless leg syndrome all the time and what in the world is that?

Dr. Jeffrey Kronson: We don’t really know what causes it, but it’s mediated by the nerves in your body, and it’s an un-attributed firing of the nerves and makes people feel that if they move their legs that sort of anxious feeling gets released and it’s good for a few minutes when they move around, but then that feeling comes again and the only way for that to relieve that feeling that they need to move is to move.

Teri Struck: So you’re talking like that you shake your legs or….?

Dr. Jeffrey Kronson: Yeah. And it occurs mostly at night when you’re sort of not concentrated on anything else. In the day – especially when you’re walking or doing exercise – it’s totally blocked out by the other impulses that your nerves are receiving. But when you’re sitting there and trying to get to sleep in the middle of the night, that’s when it tends to bother folks the most. There are medications to take care of those symptoms but that’s sort of a regimen of a last resort, and it has nothing to do with your veins.

Teri Struck: Has nothing to do with your veins. So…

Dr. Jeffrey Kronson: That’s correct.

Teri Struck: lets get back to we were talking about just the appearance of your veins. Lets just say you’re having none of these symptoms, but you look down and you see either a, lets talk about the bulging veins first, where you do surgery.

Dr. Jeffrey Kronson: Well if someone was to go after your bulging veins or your severe spider veins without doing an ultrasound of the leg, that would border on malpractice. If somebody has gallstones and you give them a pain pill to take for the rest of their life that’s not good medicine. You got to take out the gallbladder, okay. If you have varicose veins the varicose veins are a symptom of underlying chronic venous sufficiency. The saphenous vein, which is the longest vein in your body, runs from your ankle where it starts and up to your groin….

Teri Struck: Are you talking about the inner thigh, the front of your leg, the….

Dr. Jeffrey Kronson: Yeah, it runs from your inner thigh or your inner ankle right up the inside of you calf, the inside of your thigh, all the way up to your groin. Now that vein is part of the superficial venous system. It’s the one that’s most commonly affected and therefore most commonly treated for venous insufficiency. We’re not really talking about the deep veins, the ones that run next to your bones. Those can also have problems with valves, but we can’t treat those very easily. The superficial venous system, when successfully treated, gets rid of venous insufficiency and all the associated issues that go along with it in 85 percent of the cases. So when someone has bulging varicose veins Teri, the first think I do is order a venous duplex, and they’re going to look at the clients or the patients legs when they’re sitting, lying down and standing and make sure that the blood continues to get pumped up towards the heart. If the blood starts pooling down towards the feet, that tells the technician doing the ultrasound that the valves aren’t working and the diagnosis of venous insufficiency is made. Now once I have that diagnosis I can proceed with treatment.

Teri Struck: And the treatment is?

Dr. Jeffrey Kronson: Well it’s a multi part sort of thing. Traditionally there’s something called ‘vein stripping’ that vascular and general surgeons used to do. We used to make an incision in the groin, make an incision at the ankle, pass a steel or plastic catheter through the entire saphenous vein, which in my leg is about two and a half feet long. We would tie one end to the catheter and pull it out rather vigorously. Now it worked to get rid of the venous insufficiency ‘cause we were removing or stripping the vein, but it was terribly barbaric. Patients got tremendous bruising, they would bleed after surgery, there was a lot of neuropathy or nerve pain, and there was even returns to surgery. Fortunately in 2001-2002 endovascular venous ablation became common, and now that is the first line therapy when one is diagnosed with an incompetent venous system.

Teri Struck: Okay, so you’re talking to your average listener; so what does that mean? Explain ablation for our listeners.

Dr. Jeffrey Kronson: Sure. Instead of removing the veins, we’re going to put a catheter percutaneously or through a tiny one to two millimeter incision in the skin into the vein. We’re going to use a heat source, either generated by laser or radio frequency, to heat up the catheter that’s inside the vein. And essentially using that heat we’re going to seal that vein shut. It’s going to turn into a two millimeter fibris cord. The body is going to take away that scar tissue in about six months, so if you were to operate on someone looking for that vein, in half a year you wouldn’t even be able to find it. So that’s done through a two millimeter incision. There is virtually no bruising, no pain, no scarring and no return to surgery after that procedure. That’s called venous ablation. Now there’s two kinds of venous ablation. The more popular is called RF Ablation; that’s the venous closure procedure, and your listeners can get more information about that on their website, which I believe is vnus.com, v-n-u-s, dot com.

Teri Struck: And you can also go to personallifemedia.com and we’re going to link up all these websites.

Dr. Jeffrey Kronson: Absolutely. The second is EVLT, or Endo Venous Laser Therapy, and that’s where the laser source is used in the same fashion to seal the vein shut. The reason that’s a little less popular is the complication rate after laser ablation is about two to five percent, where with Venous, RF ablation – excuse me – it’s less than one percent. The two different modalities produce slightly different complications, but both are significantly less than the old-fashioned vein stripping.

Teri Struck: So the end result though would be first of all your health. You want to make sure that you’re healthy and you’re doing this for the right reasons. But a lot of women are considered just about their appearance. Much like cellulite, they don’t like the looks of cellulite, they do something about it. Is it dangerous to do something cosmetically for you veins if you don’t like them?

Dr. Jeffrey Kronson: Absolutely not. It’s very, very safe these days, and there’s many modalities to take care of the cosmetic part of the problem. Once you’ve even, once you’ve been proven to not have venous insufficiency, or the venous insufficiency has been taken care of, then we can move on to the cosmetic aspect, and I do, about 70 to 80 percent of my patients move on to that aspect. There’s a various different modalities to treat the cosmesis. One of the most common and easiest things to do is sclerotherapy. That means injecting the spider veins with a very tiny needle with some saline solution and a detergent, we use something called Sodium Morrhuate. What that causes is the blood in those spider veins gets replaced with this chemical that causes the vein walls to stick together and those spider veins disappear. They actually disappear from sight when you inject the saline solution ‘cause it replaces the red blood with a clear solution and you can’t see them. It’s pretty dramatic. That’s a way to take care of the tiny veins. The next section of veins is called reticular veins, and those are the blue veins that you see running under your skin. They’re about one to three millimeters in diameter. You can inject those, although there’s a limit to the amount of the sclarosent that you can put into somebody. More commonly now is laser ablation. This is a non invasive procedure where a laser head is applied to the skin surface and pulses of light energy are used to rid the person of the veins. Typically clients come back for two or three sessions in a specific area. This involves no needles whatsoever. We also do foam sclerotherapy for larger veins. It’s similar to the first sclerotherapy that I mentioned, except rather than a solution being injected the solution has air or Co2 introduced to it and it becomes foamy. That goes into larger veins and eventually the veins turn into fibris scars that are removed by the body; that’s also done with a needle. Finally there’s a procedure called microphlebectomy, and there are various different methods of doing this. A two millimeter incision is made and the vein is grasped by the surgeon and removed, sort of teethed out of the skin. That’s the physical removal of those large varicose veins that can still be symptomatic and painful even though the underlying problem, the venous insufficiency’s, been taken care of. That requires some form of anesthesia and usually there’s a downtime in that particular part of the procedure of anywhere from two to seven days.

Teri Struck: Well I’m going to be asking you some more questions. This is like a ton of great information if you’re suffering from vein problems. We’re going to be right back. This is Teri Struck, host of Beauty now, and we’re talking with Dr. Jeff Kronson.

Teri Struck: This is Teri Struck. I’m back with Beauty Now, and we’re talking all about leg veins today. If you have leg veins, spider veins, anything like that get your pencil out because this is really great information and you’ll be able to find a specialist near you – we will always stress board certified. And we’re talking with board certified general and vascular surgeon, Dr. Jeff Kronson today. Welcome back Jeff.

Dr. Jeffrey Kronson: Thank you. It’s good to be here Teri.

Teri Stuck: Well thank you so much and we were talking about all the different types of veins, and is there anything else you can tell us about varicose and spider veins? Do they return after treatment?

Dr. Jeffrey Kronson: That’s a good question. People often ask, “Well if I get this treated now what’s going to happen down the line?” Traditionally the recurrence of varicose veins after the treatment we mentioned, which is treating the saphenous vein, the underlying problem, getting rid of the spider veins or getting rid of the varicose veins is about 15 to 20 percent at 20 years. Those data were developed when we used to strip the saphenous veins. We’re finding that with the minimally invasive procedures – either the venous closure procedure, which I do, or EVLT, laser ablation of the vein – that the recurrence rate down the line is only about five to eight percent. Now we only have data out to about eight or ten years, but this seems to be a significant difference between traditional treatment of varicose veins. So yes, it can come back and yes there are other procedures that we do if it does, but most folks will be successfully treated by Endo Venous Ablation and the treatment of the cosmetic problems.

Teri Struck: So lets talk about, lets just say you go in and you diagnose somebody that they do have a vein that’s going to need laser surgery on. Do you need pain meds? Do you need anesthesia? What’s the procedure?

Dr. Jeffrey Kronson: Well with laser ablation we’re talking about for cosmetic concerns, it’s not a particular painful procedure. I run a laser center where we do this and I did it on myself, so I would know. And I’m pretty much a wimp; I cry at a haircut.

Teri Struck: Really, you think so? You think you’re a wimp, ‘cause I think I’m the biggest wimp on the planet? I’m pretty sure I want to be put out for even getting Botox.

Dr. Jeffrey Kronson: I don’t have much of a pain tolerance. That being said…

Teri Struck: You’re a real man to admit that.

Dr. Jeffrey Kronson: Yeah, well I know my limits. And the thing is I didn’t find it particularly painful. It’s like someone snapping you with a rubber band. And there’s four or five firings of the laser in a particular area and then move on. We use numbing cream of various sorts to take away the intensity. It’s very well tolerated. There’s no downtime whatsoever; there’s no scarring, there’s no bruising, and people can go out and do their regular activities right afterwards. No one’s going to know you had it done except for you.

Teri Struck: Well that sounds good. That’s what we want. We want privacy, that’s for sure.

Dr. Jeffrey Kronson: Well there are other issues. People come with (unintelligible) veins. What I mean by that is you’ve treated the saphenous vein, you’ve treated some of the varicose veins and they still have some problems, especially by the inside of the ankle. There’s a type of brain called a perforating vein. As we talked about earlier in the podcast, there’s a superficial system and a deep system. They’re connected by a bridge called the perforating vein. That vein also has a valve in it, and if that valve isn’t working properly there are various different procedures to take care of the perforating vein, which is sort of a second or third line therapy if the first line stuff didn’t work.

Teri Struck: And what would that be?

Dr. Jeffrey Kronson: Well we can make a small incision and put a clip or a tie on that vein. We can use a laparoscopic technique which means using a scope and enlarging the space between the skin and the muscle in your leg creating a virtual space and finding those perforating veins through very small incisions which are far way from the problem, putting a clip on them. And also we can use radio frequency ablation, putting the catheter in those veins and sealing them up with radio frequency or ultrasound energy. If that doesn’t work, then the very last bastion of treatment is to take a look at the deep veins. And about five to eight percent of people will have problems with venous insufficiency in their deep system. About 20 percent of that five percent – or one percent of all venous insufficiency patients – will need to have something done with those deep veins. That’s a big deal. We have to repair or shore up the valve in that deep system; that requires a general anesthetic and those are very specific operations that about five to seven vein centers in the United States handle well. The success is only about 50 or 60 percent and sometimes patients are left with lifelong problems that are very difficult to deal with.

Teri Struck: And I would assume that you’d be hospitalized for something like that. Would that be true?

Dr. Jeffrey Kronson: Absolutely. If you’re going to have general anesthetic and someone’s going to make a big incision on your leg, you’re going to be in the hospital for a couple of days. The good news about those kinds of operations is the treatment if it works is fairly immediate. You go from having a system where the valves don’t work to where they do. So there’s no time to sort of recover from the success of the procedure, it works right away, and right away your leg starts getting better. But really those cases are few and far between, and like I said there are specific referral centers that I can make your listeners aware of if they’re interested.

Teri Struck: Definitely we want your referrals because I think that we’re trying to stress safety here, so we’re definitely going to link you up, personallifemedia.com, and we’re going to be able to go to Dr. Jeff Kronson’s website and you’re going to be able to call him, email him and figure out who’s the best doctor for you in your area. And so who is the youngest patient that you see?

Dr. Jeffrey Kronson: I see, I’ve seen patients that are 16 and 17 years old. One thing I didn’t mention earlier on was that varicose veins are often congenital. If your mom or your sister has them or your grandmother you are probably going to get them, even, you know, whether you’re a man or a woman and I see an equal share of both. I’ve treated patients in their late 90’s as well. If they have a physiological problem, something that’s definable by ultrasound, and they’re having symptoms, there’s no reason they shouldn’t have a minimally invasive procedure even if their life expectancy’s only a couple of years, so I’ve sort of seen the whole gamut. The other thing that’s interesting is if you have a problem in one leg you’re 70 percent as likely to have a problem in the other leg, if you don’t have symptoms. So I do a lot of preventive care. If somebody’s got bad symptoms in one leg or bad varicose veins and the other leg’s okay I’ll treat the other leg as well so that the bad, the good leg doesn’t turn into the bad leg.

Teri Struck: Well you just brought up something really important. What can we do to prevent veins?

Dr. Jeffrey Kronson: Well if you have valvular incompetence there’s not a whole lot you can do. If you’re going to get them by genetics you’re going to get them. If you stand a lot, wearing compression stockings will keep the valve leaflets together and give you a longer lifespan until you need an intervention. Jobst or Juzo stockings are sort of the tight compression stockings, and when you’re an older person getting those on can be quite a chore. They’re very difficult sometimes to comply with, especially in the hotter climates such as southern California where I live, and people don’t tend to wear them. You can get good at a profession that doesn’t require you to be on your feet all day. People who have a lot of pregnancies, when the uterus expands it sits on the pelvic veins and it pops open the valve; those folks are at risk for having venous insufficiency as well.

Teri Struck: Ocotomom will be in to see you soon, I’m sure.

Dr. Jeffrey Kronson: She may. She may down the line…

Teri Struck: Well she may not. She may be one of the lucky ones. We don’t know.

Dr. Jeffrey Kronson: The most important thing Teri, if I could just close with, that you have to make sure that your doctor is practicing with his, within his or her area of expertise. A lot of people claim to be vein specialists. Many are but many aren’t, and unfortunately as a referral source for a lot of physicians I see a lot of complications. Your doctor has to know what they don’t know, and if they’re not board certified, either in vascular surgery, general surgery or they don’t belong to the American College of Phlebology, you may want to get a second opinion because somebody who’s treating spider veins without knowing what the underlying problem is can harm you. It’s always important to put the patient first, and as we say, first do no harm.

Teri Struck: Right. And I, we always stress on every show is go to somebody – and this is your specialty, a vascular surgeon. We don’t go to dentists for breast augs, so that’s really, really important to do your homework.

Dr. Jeffrey Kronson: I couldn’t agree more.

Teri Struck: So in closing, what else could you tell us the very, very end? We talked a lot about the leg vein surgery; what about spider veins and the little, you know, laser zapping that you did, you touched upon that briefly. Lets close with that.

Dr. Jeffrey Kronson: Well people have a lot of facial telangiectasia that we treat as well. So telangiectasia means tiny little veins around the nose, around the nares, your nostrils, on the cheeks; all that can be treated successfully with laser treatment to the face or photo facials.

Teri Struck: What kind of laser do you use photo facials for that?

Dr. Jeffrey Kronson: Well we use IPL, so we use Intense Pulse Light. The company that we like is called Syneron, but there’s a lot of good products.

Teri Struck: I love Syneron. Syneron has great products.

Dr. Jeffrey Kronson: Well they combine radio frequency and laser light energy in order to deliver the least amount of energy required to get rid of the problem. There’s no burning, there’s no scarring, there’s no downtime, there’s really no redness. We treat these veins on the face with a laser. After I would say two or three treatments they’re gone for good. And you can get them done on the lunchtime; we call it the lunchtime photo facial. You go back to work and people will think that maybe you had a little bit of sun and that’s about it. The only person that will know is you.

Teri Struck: And that’s good for Rosacea as well, isn’t it, the IPL?

Dr. Jeffrey Kronson: Yeah, absolutely. IPL is excellent for any brown or red discoloration on the skin. When the skin creates spider veins, when you get Rosacea, when you have brown pigmentation, the skin is trying to protect itself from the UV light from the sun, it’s protecting itself against cancer, so it forms these shields of pigment, and that can be quite unsightly if people have been exposed to sun without proper sunscreen for a lot of their life, and again, especially here in southern California. So IPL will bring that pigment to the skin, it’ll flake off like pepper flakes and you’ll be left with nice smooth looking skin with no cosmetic defect. And it really works; the technology has…

Teri Struck: It does really work. I love it. I love it. I personally love that, I love (unintelligible). I think it’s just great upkeep regardless.

Dr. Jeffrey Kronson: Well it’s amazing what you can do non-invasively here. I’ve got a lot of friends that are plastic surgeons and they do great work. But you don’t have to go to the plastic surgeon first. You can try a lot of non invasive therapy and then don’t burn any bridges, when you want to have cosmetic surgery everything is left in tact and you haven’t violated any skin planes and you’re a fresh patient that they can do wonders with.

Teri Struck: It’s always good to keep your skin up. We’re running out of time. I can’t believe it; I have so many more questions. We’ll have you back. Thank you so much for all this great information. Obviously if you have leg vein problems it’s going to be solved, go to personallifemedia.com. You can also email me at t-e-r-i, @personallifemedia.com, with any questions you have for Dr. Jeff Kronson ([email protected]). And also check out some of our other shows – Dr. Perricone, Dr. Brent Moelleken, we have some really great shows on lasers, lifts, lashes, hair. You name it we probably have it. Beauty Now. Thanks again Dr. Kronson for being with us. It’s great information and it was a pleasure talking to you.

Dr. Jeffrey Kronson: Thank you Teri for the opportunity.

Teri Struck: Thanks a lot.